Effect of intracardiac potassium chloride for feticide before dilatation and evacuation on procedure duration and outcomes
Awarded 2012
Large Research Grants
Patricia Lohr, MD, MPH

Objectives: The primary objective was to assess the safety and efficiency of dilatation and evacuation with and without feticide using intra-cardiac potassium chloride. Methods: We conducted a prospective service evaluation at 3 abortion clinics in England. We compared procedure duration, complications, and acceptability of dilation and evacuation before and after feticide was removed from organizational clinical guidelines. All women meeting the following criteria were included: gestational age 22-23+6 weeks, or 18-21+6 weeks and either <=18 years old, body mass index (BMI) >=33, or >=2 Caesarean sections. Results: From 2/1/14-7/31/14, data were collected on 291 women undergoing dilation and evacuation with feticide, and from 8/1/14-1/31/15 on 257 who did not have feticide. Unadjusted mean procedure time was shorter with feticide than without (12.7 vs 16.1 minutes, p=0.000). Feticide remained independently associated with a mean decrease in procedure time of 3.8 minutes (95% CI 2.7-4.9) when adjusted for age, parity, prior Caesareans, gestation, BMI, surgeon, number or duration of osmotic dilators in situ. The overall proportion of complicated procedures did not differ (7% vs 4%, respectively, p=0.1). Uterine atony was more common with feticide (3.1% vs 0%, p=0.004), despite receiving prophylactic utero-tonics more often (82% vs 73%, p=0.01). Patients having feticide reported more nausea (31% vs 19%, p=0.001) and pain (49% vs 25%, p=0.000). Most women in both groups found their procedure acceptable (66% vs 78%, p=0.2). Conclusions: Intra-cardiac potassium chloride reduced operative time of dilation and evacuation but this relatively modest benefit must be weighed against more frequent side effects and risk of atony.